Yoga enthusiasts have used nasal irrigation for thousands of years to clear the sinuses and the mind. Today, nasal irrigation is becoming more widely accepted as a home remedy for allergies, colds, and sinus infections. Nasal irrigation can be performed up to twice daily at home or in a doctor's office, as long as it does not irritate the mucous membranes.

There is variability in nasal irrigation techniques. Differences include the method of saline delivery, the strength of the saline solution, and the use of other additives. Delivery methods include the traditional neti (irrigation) pot, nasal sprayer, bulb syringe, cupped hand, and commercially available devices. The strength of the saline solution depends on the amount of salt added to the water. Additives have included antibiotics, substances that narrow the blood vessels (called vasoconstrictors), and buffers, which reduce acidity. Some practitioners recommend buffered hypersaline solution, although this may irritate the nasal tissues. Gravity-fed normal saline is often used in Jali Neti, one form of nasal irrigation.

There is growing evidence to support nasal irrigation because it is more natural, soothing, generally safe, and less expensive than many over-the-counter medications. It also does not cause side effects often associated with these medications, such as drowsiness and nausea.

The International Consensus Report on the Diagnosis and Treatment of Rhinitis recommends nasal irrigation for the treatment of swollen nasal airways (called rhinitis). There is good evidence for the use of nasal irrigation in allergic rhinitis and sinusitis. There is also promising early evidence that nasal irrigation may help treat the common cold, respiratory symptoms from occupational exposure, and wounds after sinus or nasal surgeries. Nasal saline irrigation is still the main treatment for acute rhinitis in infants because excessive use of nasal drops that narrow blood vessels is unsafe in early childhood.

It is unclear how saline nasal irrigation may work. It has been suggested that nasal irrigation may clear mucus, improve the function of the tiny hairs that move mucus through the nasal passages, reduce the number of particles that stick to the inside of the nasal passages, decrease swelling, and/or decrease levels of chemicals that cause swelling. It has also been suggested that heat from nasal irrigation may directly interfere with allergens. Vapor may stabilize the mucosal surface and reduce symptoms of congestion and a runny nose.

In traditional systems of healing, nasal irrigation is believed to help prevent against disease and improve symptoms of a variety of nasal and sinus conditions.

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

GRADE *

Several studies suggest that nasal irrigation with normal or hypertonic saline may effectively treat allergic rhinitis in adults and children. Better studies are needed before a strong recommendation can be made.

B

Early research suggests that nasal irrigation may help treat chronic sinusitis, with improvements in sinus-related quality of life, decreases in symptoms, and decreases in medication use. Further study is needed before a strong recommendation can be made.

B

Early research suggests that hypertonic saline aerosol may enhance the clearance of lung secretions. More studies are needed.

C

Early human studies found that nasal steam inhalation may not improve common cold symptoms. Well-conducted research is needed to make a more compelling case.

C

There is some evidence that saline nasal irrigation or inhaled steam may improve mucus clearance in people with cystic fibrosis. Some studies have added antibiotics or drugs that affect cellular sodium channels. Further study is needed.

C

Studies have examined whether the amount of bacteria in the nasal passages before and after nasal surgery can be reduced by nasal washing (with or without added antibiotics or corticosteroids). Although some evidence suggests that bacteria are reduced, it is unclear if this therapy reduces the risk of infections after surgery.

C

Early evidence supports the use of nasal irrigation for respiratory symptoms or diseases caused by occupational exposure to dust or air pollutants. In addition, several studies suggest that nasal irrigation may be used to examine the inhalation effects of acute occupational exposure, especially to pollutants. More research is needed in this area.

C

* Key to grades

A: Strong scientific evidence for this useB: Good scientific evidence for this useC: Unclear scientific evidence for this useD: Fair scientific evidence for this use (it may not work)F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory
The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Safety
Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Nasal irrigation is likely safe for the general population when used daily with proper technique. There are some reports of nasal irritation, nasal discomfort, itchiness, earache, cough, sneezing, nosebleeds, increased allergy symptoms, dizziness, and pooling of saline in the paranasal sinuses.

Some preparations include drugs that may cause side effects. Studies using saline plus ephedrine added have noted brief episodes of irregular heartbeat, lightheadedness, and nasal burning in a few people. Cystic fibrosis patients have experienced increased cough (that sometimes included blood), throat irritation, and chest tightness.

Nasal irrigation should be used cautiously in people with frequent nosebleeds.

After nasal surgery, nasal irrigation should be discussed with the surgeon.

People with impaired gag reflexes, such as patients with chronic illnesses or recovering from surgery, may be at risk of fluid entering the windpipe or lungs (aspiration). A healthcare provider should be consulted before starting therapy.

Irritation or burning of the nasal passage may occur if the irrigation solution is too hot.

Bacterial infections from dirty equipment are possible.

In children, nasal irrigation is sometimes performed by healthcare providers. Limited research suggests that nasal irrigation is safe in children older than seven years. However, the safety in children is unclear when nasal irrigation is performed outside of a doctor's office.

To prevent bacterial infections, disinfection treatment is effective if associated with carefully selected materials, good circuit design, and good maintenance practices.

Nasal irrigation may affect the action of other drugs, herbs, and supplements, such as antibiotics, antihistamines, anti-inflammatories, antivirals, cough suppressants, and nasal sprays.

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.